PHM HISTORIAS

8/13/2019 PHM HISTORIAS

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Third World Relief Fund Steunfonds Derde Wereld Fonds de Soutien Tiers-Monde

December 2010

Most Signifcant ChangeMonitoring empowerment for the right to health


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This booklet has been produced with the nancial support of the Belgian Directorate-General for

Development Cooperation (DGDC). We hope that it will inspire you in your own work, but if you

wish to reproduce some of the texts on the Internet or in another publication, we would appreciate

it if you could mention the original source.

Contributors: Wim De Ceukelaire, Danny Claes, Anuschka Mahieu, Fanny Polet, Jayson Fajarda,

Hans Schaap, Annelies Vermeir, Lien Jespers, Kaat Pierreux, Sylvie Luzala, Mara Erlinda Sandino,

Mara Hamlin Zuniga, Gabriel Garca, Arturo Quizphe and Jorge Quizphe.

Layout : Peter Zwertvagher (Brutal You!)

Brussels, December 2010.

Please contact us at: [email protected]

If you want to nd out more about MSC, please visit

http://mande.co.uk/special-issues/most-signicant-change-msc/


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Table of Contents

1 Introduction 4

2 Experiences 6

2.1 Palestine 6

2.2 The Philippines 12

2.3 Latin America 18

2.4 Democratic Republic of Congo 34

3 General conclusions and recommendations 37

3.1 Final selection 37

3.2 Observations 38

3.3 Recommendations 39

3


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1 Introduction

Anyone who is involved in development work knows that monitoring and evaluation

can be challenging. It is no easy matter to measure progress and to communicate

achievements and results in formal reports, especially for organizations that are not

investing in bricks and mortar, but in human and organizational capital.

Theres one anecdote about monitoring and

evaluation Ill never forget. A couple of years

ago I was representing Belgian NGOs in the

Philippines. One day I found myself on theisland of Samar working overtime with our local

partner organization to come up with indicators

for our logical framework. It took us ages to nd

an indicator of poverty among the poor peasants

we were working with. I had already tried every

indicator I knew from training programmes and

manuals but nothing seemed to be applicable,

according to the director of the local partner

organization.

On the verge of losing my patience, I nally

asked her to tell me about a successful project

area she had mentioned earlier during the break.

How did they know that they had been able to

improve the lives of the poor? She immediately

started to enthusiastically tell me about their lat-

est visit to the village and the many changes they

had observed in the behaviour and living condi-

tions of the local population. One of the most

striking changes was that almost everyone was

now using sugar and cooking oil.

There was my indicator. And I had learned my

lesson: ask people to tell stories and youll learn

plenty of things that cannot be captured in indi-

cators. Maybe it was also my rst encounter with

the Most Signicant Change technique, long

before I had even heard of it.

During the same period, I met a development

consultant who had returned from a eld visit

for an ambitious evaluation project commis-sioned by the Belgian government. You guys

know what empowerment is, he told me. I was

attered, of course, but also curious. How had

he reached that conclusion? He had been in-

terviewing farmers all over the Philippines, he

explained, and most of them were very shy and

hesitant when they were answering his questions.

When I interviewed farmer leaders in your

partners project areas, they stood up before

they answered my questions and they lookedme in the eye while they made their points, he

averred.

This observation never made it into the con-

sultants nal report but now that Im looking

back on our initial experiences with the Most

Signicant Change technique, this anecdote

seems very relevant. These kinds of stories and

anecdotes often reveal most about the issues that

really matter in our work: empowerment, health,well-being, rights, etc., and yet they hardly ever

make it into our formal reports.

It was out of frustration that we decided to

experiment with the Most Signicant Change

technique. We had been struggling hard these

past few years to adopt results-based manage-

ment techniques but often we had an uncom-

fortable feeling that something was missing. We

hardly ever heard the stories from grassroots

level any more - that wealth of quality informa-tion that shows what matters most for people

and for us.

4


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When we read about the Most Signicant

Change technique, we thought it might provide

an answer and we wanted to give it a try. We

collected and selected stories with the help of

our partners in the Philippines, Palestine, the

Democratic Republic of Congo (DRC) and

Latin America. Interestingly, in each of these

regions the process was quite different. In the

Philippines, a staff member from our local ofceworked closely with Gabriela, one of our partner

organizations, to conduct a try-out of MSC with

a regional Gabriela chapter. In Palestine, we

had rst-hand experience, as we collected and

selected the stories ourselves, together with youth

leaders in East Jerusalem. In the DRC, it was

three interns who worked with the local partner

to collect stories, and in Latin America, a local

consultant assisted the local partner organiza-

tion.

We consider the diversity in the methodology

a strength, not a weakness. It provided us with

a wealth of experience to learn from in a very

short time. We want to share these experiences

the good as well as the bad with a broader

audience involved in this kind of work and hope

it will enable them to improve their work in the

service of peoples health and development.

Wim De Ceukelaire

Coordinator of the Policy and Partnership de-

partment

Third World Relief Fund (TWRF)

5

1 Introduction


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2 Experiences

2.1 Palestine

6

In Palestine, TWRF works with Health Work Committees (HWC), a local NGO, striv-

ing for the empowerment of young people in East Jerusalem. HWC is an important

player in Palestinian civil society in this part of the city and is well-established

among young people there. It organizes school health programmes in most Palestin-

ian schools in the city and also runs a youth centre in the Old City, the Nidal Centre.

The original building used by the Centre was closed down by Israeli security forces

in July 2009, so the Nidal Centre now organizes its activities from ad hoc venues.

2.1.1 MethodologyWe scheduled the collection of MSC stories dur-

ing a mission of TWRF staff to Palestine from

26 to 28 July 2010. The objective was to collect

stories from the youth volunteers in Jerusalem

who are active in the Nidal Centres youth

network (local community groups and theme

groups), school health committees and univer-

sity student groups. Due to time restrictions and

the summer holidays we were not able to meetvolunteers from the university groups.

It was not our intention to carry out an assess-

ment of the programme. Instead, we wanted

to learn about the impact of the activities on

young people by listening to the stories of vol-

unteers concerning the most signicant change

in their lives and how their participation in the

programme has changed their behaviour and

opinions.

Brieng

The MSC manual was sent to Daoud, the HWC

youth coordinator in Jerusalem, three weeks

before the stories were actually collected. At the

start of the TWRF mission, we discussed the

objectives and procedure of the MSC technique

with Daoud, making use of a computer presen-

tation.

Dening domains of change and report-

ing period

Together with Daoud, the TWRF staff dened

four domains of change about which the volun-

teers were asked to tell a story:

MSC in their daily lives

MSC in their views on health

MSC in involving peers in activities MSC in general (open domain)

The reporting period was not the same for eve-

rybody. The volunteers were asked to talk about

the period since they had become a volunteer

with the youth network (1-3 years).

Participant selection

Daoud selected the volunteers. Although selec-

tion criteria were discussed in order to ensure

that interviewees would represent the different

target groups of the programme, most arrange-

ments with the volunteers were made at the last

minute and improvisation prevailed over selec-

tion. The volunteers were given a brief introduc-

tion in Arabic about the MSC technique, over

the phone or just before they were asked to tell

their story.


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7

Participants:

1. Meriam, 21 years old, third-year economic

science student at Al-Quds University, local

community group.

2. Ihsan, 18 years old, just nished secondary

school, joined Nidal 18 months to two years

ago, local community group.

3. Samoud, 17 years old, 5th year second-

ary school, member of the dabke folk

dance group.

4. Mustafa, 16 years old, local community

group, Shufat.5. Azedin, 16 years old, local community group,

Shufat.

6. Bassil, 16 years old, joined the Nidal Centre

three years ago, local community group,

Shufat.

7. Nadine, 17 years old, about to start nal year

of secondary school, joined Nidal Centre four

years ago, local community group.

8. Bashar, 17 years old, joined the Nidal Centre

a year ago, school health committee.9. Bassem, 17 years old, volunteer for the past

four years, local community group.

Story collection

Each volunteer talked for about 45 minutes. Not

everyone told a story about all four domains,

although most did.

Circumstances in which the stories were col-

lected:

The stories were collected by two TWRF staff

members and documented in English.

The TWRF staff members explained the

objectives of the MSC technique and asked

the volunteers about the most signicant

change since they had become a volunteer in

the youth network in the four dened domains.

We also asked them to explain why it was the

most signicant change in their opinion.

The volunteers spoke Arabic. Daoud, the

HWC youth coordinator, translated everythinginto English on the spot.

Story selection

After the story collection, the two TWRF staff

members had a meeting with Daoud and three

volunteer youth leaders on the last day of their

mission to discuss the stories and select one

representing the most signicant change within

each domain. After reading the stories for onedomain out loud in Arabic, the youth leaders

discussed which story they thought reected the

most signicant change. The same procedure

was repeated for each of the four domains. After

each discussion, they explained in English why

they had chosen that particular story.

2 Experiences Palestine


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2.1.2 MSC stories

Samoud, 17 years old: dabke dancing

gave me self-condence

5th year secondary school, volunteer for three

years

Domain: most signicant change in daily life

Before I got involved in the Nidal Centre, I

didnt have much contact with people outside my

family. Through the Centre I have got to know

many new people and places in Jerusalem. I like

dabke dancing1, so I joined the dabke team. But

thats not all. I learned a lot about the Palestini-

an case. We visited villages and cities in Palestine

482(Israel) and also learned about the destroyed

villages3. Thats why we decided to make a pres-

entation during our summer camp on the ethnic

cleansing. During our tours in Jerusalem we

learned how Israel is changing the history of our

city. Arab houses are turned into Jewish housesby removing Arab inscriptions of the Koran. In

Silwan4, 1,500 people will be evicted from their

homes (which will be demolished in order to

build a park). The children appreciated this tour

very much.

The most signicant change in my daily life

since I got involved is that I am more self-

condent. I recall a dabke show we prepared

two years ago. It was our rst performance andwe invited all our friends and family. It was due

to take place at the National Theatre in East

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Jerusalem. The audience had already arrived

and we were ready to start. One hour before the

performance, the Israeli police came and can-

celled it. They had a paper on which was written

that we didnt have a permit. Everybody was

upset and it made me cry. But it also made me

more determined to continue and it boosted my

self-condence.

Why was this the most signicant change?

I learned that we are living under occupation

and that I have to be strong. This is our country

and they will not stop us from performing dabke

and organizing our activities. I was raised to love

my country. When I was a child the Israeli army

arrested my father right in front of me, pointing

a gun at him. I want to tell the world that they

are the terrorists, not us.

The HWC youth leaders chose Samouds story

because it is very comprehensive, both about the

activities and about society.

Samoud is a girl who didnt have many friends

before. Now she has many contacts and friends.

The story is complete and shows how she

learned things at every stage of her life. It really

demonstrates how she has developed as a whole

person. Thats also how we understand health:

as a quality of life. Initially she only came fordabke. It changed her life, really!

The four selected stories were the following:



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Ihsan, 18 years old: People have to ght

for the right to health

Just nished secondary school, joined the Nidal

Centre two years ago

Domain: most signicant change in views on health

With our group from the Nidal Centre we visited

families who were evicted from their homes in

Sheikh Jarrah5. These families are now living

on the street in conditions that are not healthy

at all. When I visited this place I was shocked.

The families were thrown out of their homes

and Jews are now living there. These peopledont have anywhere to live, they have no food

for their children. It was so unfair. To me, it

demonstrated the contempt shown towards these

people. It shows that the occupation forces really

want to take everything.

This visit taught me that health should be a right

for all and not a gift. It is not because youre a

good man that you should be able to enjoy this

right. I believe that everyone should have theright to live in good and healthy conditions and

to have a house to live in.

The visit to Sheikh Jarrah made me think: it

is the State that should ensure this right but it

doesnt. Thats why people have to ght for this

right.

Why was this the most signicant change?

This experience was very important to me

because its one of the most important problems

Palestinians in Jerusalem are experiencing right

now. I also know a family that is in the same situ-

ation.

The HWC youth leaders chose this story be-

cause it talks about visits to evicted families in

Sheikh Jarrah. Its a very important case that af-

fects the Palestinians in Jerusalem. Because they

lost their homes, they lost their right to health.

Through this activity Ihsan understood that

health is really a right for all and that the gov-

ernment is doing nothing. In fact theres nobody

to defend these peoples rights.

Another story in this domain was about drug useby young people. It was also very good, because

these boys became aware that they were able to

do something about this issue.

Meriam, 21 years old: I wanted my sis-

ters to have the same experience

Third-year economic science student at Al-Quds

University

Domain: involving others

Im now more self-condent to invite others to

join and I know how to invite them. I succeeded

in getting my two younger sisters involved.

Because of my experiences, which I shared with

them, and because of the change in my behav-

iour, they became interested in joining them-

selves. Now theyve taken part in the summer

camp and one of them is doing the leadership

training.

Initially, people are afraid to join but once they

get involved we can see the change. Young peo-

ple dont know the issues, so theyre hesitant at

rst.

Why is this the most signicant change?

Its important because I want them to have the

same experience and to acquire the same skills

and knowledge.

The HWC youth leaders chose Meriams story



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because it shows the change in her own interests

makes her want to see the same changes in her

family. She succeeded and her two sisters are

now very much involved.

She also talked about how young people are

sometimes afraid to join. But once they get in-

volved, they continue. Its a common experience.

Its not easy to convince them to join. You have

to nd the key that ts the door. The three boys

that were also interviewed are a good example.

They were among a group of 17. As soon as

some of them joined us, the others followed.

Activities like the summer camps and dabkedance serve to attract young people. Usually

theyre not very interested in educational activi-

ties at rst. Actually, it ts in with the plan of the

occupation forces to keep young people igno-

rant.

Ihsan, 18 years old: Im not shy any

more

Just nished secondary school, joined the Nidal

Centre two years ago

Domain: general

I used to be very shy and afraid to speak my

mind. I used to be so worried about what other

people thought of me. When I tried to give my

opinion, I thought others would disapprove.

10

Ive now learned how to relate to other people

and how to deal with them. I know how to show

respect to others and I know people also respect

me.

Why is this the most signicant change?

No one is perfect but you always have to look

for peoples good side and for the knowledge

they can offer. A bad experience is not the end

of your life. You should carry on and learn from

this experience.

This was important to me because I believe a

persons opinion and attitude really matter. The

most important thing is not to be selsh.

The HWC youth leaders chose this story be-

cause its exemplary of the big change they see

in the youngsters they work with. Initially, they

dont know how to share among themselves.

On the street they can be very tough but once

they have to talk to each other, they are shy andsilent. It is through our activities that they learn

to respect others, look for peoples good side and

share their opinions.

Sometimes, even just introducing themselves is

difcult. Its a problem of our society. In school,

young people just sit and listen. Its the same at

home.

1Palestinian folk dance.2 Palestine 48 is how some Palestinians refer to the territory that is now recognized as Israels, as it was occupied in

1948.3In 1948, some 500 Palestinian villages were completely destroyed and its residents were evicted from the territory that

later became Israel.4Silwan is a Palestinian part of Jerusalem adjacent to the Old City with a population of about 45,000 people. The area

includes the archaeological site of what is said to be the City of David, or the original city of Jerusalem. It is one of the

most contentious areas in Jerusalem these days because of plans to develop it as a tourist spot.5Sheikh Jarrah is a Palestinian residential area located to the north of the Old City in occupied East Jerusalem and is

home to approximately 2,700 Palestinians. Given the areas strategic location, Israeli settler organizations have made

persistent efforts to take control of land and property and establish a sustained presence in Sheikh Jarrah. Efforts by

settler groups have intensied in recent years and are often accompanied by attempts to forcibly evict Palestinian families

and communities to make way for new settlements. In a recent series of evictions on 2 August 2009, 53 Palestinian

refugees, including 20 children, were forced out of their homes in Sheikh Jarrah by Israeli authorities following a court

ruling. The properties were handed over to a settler organization that intends to build a new settlement in the area, plac-ing at least 24 other buildings and their estimated 300 residents at risk of forced eviction. When similar efforts in other

parts of Sheikh Jarrah are taken into account, the total number of planned settlement units rises to over 540, placing an

estimated 475 Palestinians at risk of forced eviction, dispossession and displacement. (Source: OCHA)



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2.1.3 Assessment

After the story selection, the HWC volunteers

(Daoud, Nagham, Ilham and Ahmad) assessed

their experience with the MSC technique. These

are some of the points they shared:

The stories are interesting and accurate but

they dont reect the entirety of the Centres

work. We also offer human rights training,

alternative city tours, education about the

situation in Jerusalem, gender and sexualhealth training, etc., but these were not men-

tioned. Besides young people, were also work-

ing with women and children.

We should learn and study why it is so dif-

cult to recruit more young people. Thats a

general problem for all organizations here,

however. Actually, we have many more than

other NGOs.

We knew these volunteers already because they

are all active members but through this exer-cise we learned much more about them. It will

help us to deal with them better in the future.

It taught us that it is possible to have a genuine

impact on young people and see real change.

We actually need more of these centres.

MSC is a useful method and we could also use

it ourselves. We have experience with assess -

ments, but the difference with other

evaluation methods is that it shows the real-

ity of young peoples lives under the occupa-

tion. They are confronted with drugs, evictions,

violence, and much more. It shows what reallymatters to them. Through the activities of the

Nidal Centre, youngsters learn to deal with

these problems.



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2.2 The Philippines

In the Philippines we work with different partner organizations, most of whom are

active in community health. One of them is Gabriela, a national alliance of womens

organizations, with which we have been working on womens and community health

programmes since 2003. They volunteered to try out the MSC technique with the

help of our local country ofce staff.

2.2.1 Methodology

The TWRF country ofce prepared an MSCstory collection guide in Filipino and sent it to

Gabriela. Obeth Montes, who has overall re-

sponsibility for the programme, had read and

commented on the guide before sending it to the

organizers of the Iloilo and Roxas City chapters.

Actual story collection and selection in the eld

took place from 17 to 21 August.

Gabriela Iloilo chapter

The Gabriela Iloilo organizers expected 25

members to participate in the MSC story collec-

tion, but because of unforeseen circumstances,

only 12 made it on the actual day. Despite the

absence of some participants, each munici-

pal chapter covered by Gabrielas health pro-

gramme was represented, however.

Obeth explained the context of the MSC tech-nique. She told the participants that it is a form

of evaluation process that they can use, especial-

ly now that they are approaching the end of thethree-year programme. Jayson from the TWRF

country ofce explained the different steps of

the MSC technique.

Because of the number of participants, the facil-

itators decided to divide the group into six pairs.

Each pair was asked to exchange a story about

the most signicant change in the last three

years. The facilitators thought that it would be

better to pair participants from different areas.

The participants were asked to document their

partners story. The pairs were then asked to

choose which of the two stories they thought was

the most signicant.

The pairs were given an hour and a half to

exchange stories and document them. During

the subsequent presentation, each pair was given

time to present their chosen story. The partici-

pants whose stories were chosen were then asked

to elaborate to ll in the gaps in the documentedversion.

The six stories shared in the plenary session were

the following:

1. Virginia Sumaguio, Leganes, Iloilo on how

they use the herbal medicines that were cov-

ered in the training given as part of

Gabrielas health programme in Iloilo.

2. Hydie Sotela, Leganes, Iloilo the frequencyof her asthma attacks was reduced after she

used the medicinal plant sambong, which she

2 Experiences The Philippines


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learned about during a training course

on herbal medicines.

3. Gloria Galleno, Leganes, Iloilo the way she

disciplines her children changed after attend-

ing a training course on violence against

women and children. Her husband and chil-

dren became supportive of her participation

in the seminars and training organized

by Gabriela, to which they attributed Glorias

change in attitude.

4. Rosalinda Guaro, Leganes, Iloilo she did

not believe in herbal medicines before the

implementation of Gabrielas health pro-gramme in Iloilo until she applied what she

learned during training on her husband, who

was suffering from arthritis.

5. Ma. Aleta A. Gamot, Sta Barbara, Iloilo

she discovered the use of tawa-tawa (Euphor-

bia Hirta), a medicinal plant for people with

dengue fever. She recommended the use of

herbal medicines to her neighbours.

6. Elena Dela Cruz, Pavia, Iloilo she began to

understand womens issues, particularlyviolence against women. She has since at-

tended to the needs of mistreated women in

her community who sought her help.

In line with the guidelines of the technique, the

domains were determined only after the MSC

stories were gathered. This was done during the

assessment session involving the ve organizers,

including Iloilo Health Programme Coordinator

Lucy Francisco, when the stories that most ac-curately reected the MSC of the Iloilo chap-

ters health programme were identied. The

organizers chose three stories they would like to

put forward to the Gabriela national ofce for

further selection.

Based on the stories collected, the organizers

identied the domains from which they would

base their criteria for selection. The domains

identied were Impact of Services and Change

in Attitude. The stories of Galleno, Sotela andDela Cruz were chosen by the ve organizers.

They were unanimous in choosing Gallenos sto-

ry, as it aptly illustrated the Change in Attitude

domain. Coordinator Lucy Francisco said that

she did not know Gallenos story prior to the

sharing. Apart from tting into the Change in

Attitude domain, Dela Cruz story also indicated

the progress of her work in the community.

Sotelas experience was chosen from among the

many stories about herbal medicines because it

highlighted the effectiveness of the use of alter-

native medicine they, as health workers, are pro-

viding. It also indicated a change in the quality

of her own life because of her improved health.

Gabriela Roxas City chapter

The lessons learned from the way the exercise

was conducted in Iloilo led to modications

being made to improve the procedure used in

Roxas City. The facilitators decided to proceed

with the group sharing with the participants

grouped according to their communities/lo-

cal chapters. With every member of the groupfamiliar with how the health programme was

specically implemented in their communities,

they could better judge which story to select.

The context and mechanics of the session were

discussed by the facilitators before splitting the

participants into groups. With three to four

women in each group, they were given two and

a half hours for the sharing part of the exercise.

Each group selected one story. The facilitatorsand some of the organizers did not participate

in the sharing, but moved from one group to

another to observe and to make sure the partici-

pants understood and followed the instructions.

Unlike the procedure used in Iloilo, the partici-

pants were rst encouraged to share their stories

with each other before documenting them. It

was observed from the Iloilo experience that the

documentation hindered free discussion.

After the sharing, each group assigned a person

to document the story that they had chosen.



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14

The participants whose stories were chosen were

asked to narrate their story during the plenary

session. After each participant had nished, the

organizers, facilitators and other participants

asked her questions to clarify a few details or to

allow her to elaborate.

The following were the stories presented during

the plenary session:

1. Lorna Coronado, Barangay Cogon, Roxas

City she became aware of the rights of

women and advised a neighbour who was be-

ing beaten by her jealous husband.2. Dolores Mijares, Barangay Libas, Roxas City

she reprimanded a relative who was hit-

ting his child. In the process of averting

further violence, her hand was cut on the

knife wielded by her husband, who was

defending her against their relative.

3. Emma Pedrano, Barangay Culasi, Roxas City

thanks to the Gabriela organization,

the community became united and was in

spired with the courage to ght for their land.The organization raised the awareness of

community members about the issues threat-

ening their community, such as demolition

and mining.

4. Marivie Arguelles, Barangay Dumolog, Roxas

City the herbal medicine training given by

Gabriela helped her community, especially

during the outbreak of dengue fever.

5. Cristina Alcones, Barangay Baybay, Roxas

City the leadership training she received

in 2009 helped her lead her community in

the campaigns against hunger, poverty and

price hikes.

6. Elma Deanon, Barangay Dinginan, Roxas

City before, she was meek and sensitive to

taunts. As the Gabriela chairperson in Roxas

City, she became determined and gained the

strength to ght against injustice and oppres-

sion.

After the presentation, the organizers assessedthe stories shared and how the sharing was con-

ducted. For the organizers, the process was posi-

tive because the stories touched on the different

aspects of the programme, such as awareness-

raising, organizing and service delivery. These

three aspects were identied as the domains

in determining the most signicant change in

Roxas. The group decided to forward all six

stories for the national ofce to assess.

As in Iloilo, some of the stories were not known

to the organizers. They appreciated the method,

as it became a vehicle for them to learn of these

stories, which will help them assess how the pro-

gramme impacts on people in the communities.



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15

2.2.2 MSC stories

After reading the collected MSC stories from Iloilo

and Roxas City, TWRF Country Representative

Hans Schaap chose the stories of Emma Pedrano

(Roxas City) and Gloria Galleno (Leganes, Iloilo).

For Hans, Emma Pedranos story is a clear expres-

sion of community empowerment. He selected

Gallenos story, as it was an admission of personal

weaknesses and attitudinal change brought about

by the programme.

According to Hans: The stories as a whole are

a good indicator of the health programme of

Gabriela, and of the fact that the programme goes

beyond health and addresses elementary aspects of

the struggle against poverty and no right to health:

empowerment of the basic sectors through organ-

izing and education.

Emma Pedrano (Barangay Culasi, Roxas

City)

I came to know about Gabriela because of our land

problem. Our views and attitude have changed

since the organization helped us. Apart from that,

there are many things that the organization has

given to my family and to our community, not least

its role in raising our awareness and giving us the

courage to face our problems, particularly our land

problem.

A private company was claiming ownership of theland where our houses had stood for many years.

Our homes were threatened with demolition, but

because of the organization, we were able to stop

the process. Through the organization, we lobbied

the appropriate government agencies to give us the

preferential right to stay on our land.

Before, we had no guidance on what actions we

could take. We did not know which agency could

help us. We were on our own, we were not united.Some fell for the deceptions of the claimant, who

connived with local ofcials to entice some of us to

demolish our own homes in exchange for a paltry

sum. The organization exposed the fact that the

document some of us had signed was null and void

because we had signed it against our will.

I thank the organization for its help in forging unity

among us to defend our land and in nding ways

to improve our lives. Through the organization, we

were able to inform other people in our community

how to deal with our situation. Gabriela organ-ized discussions and training for us to understand

our situation. We did not give in to the threats and

harassment because we had the organization to

count on.

Gloria Galleno (Barangay Buntatala,

Leganes, Iloilo)

I was very strict with my children when I disciplined

them. I was easily angered when I heard rumours

about their wrongdoings from our neighbours. I of-

ten hit them and pulled their hair; I put them inside

a sack. Then I received information on violence

against women and children. I came to understand

that it was not the way to discipline our children.

I realized that what I was doing was wrong, and

that children also have rights. I used to think that I

am the mother, and they should obey me. I used to

think that they are just my children and they should

do what I say. I learned from the organization that

as a mother I should build a relationship with mychildren.

I often fought with my husband because of how I

treated our children. I know now how to handle ar-

guments with my children and husband. They are

all supportive when I attend seminars and training

organized by Gabriela, to which they attribute the

change in me.

GABRIELA National OfceThe MSC story collection was facilitated in coor-

dination with Gabrielas national ofce through



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16

its programme director Obeth Montes, who was

present throughout the whole process. She pre-

sented the selected stories from Iloilo and Roxas

City to the National Secretariat. They discussed the

stories and chose the following as representing the

most signicant change in their programme areas

in Iloilo and Roxas.

(1) Hydie Sotela (Iloilo)

Sotela is a barangay1 health worker who works for

the local government-funded health centre. Her

story showed Gabrielas relationship with localgovernment agencies. Through the programme,

Gabriela was able to access the barangay health

workers and further enhance their skills in health

work. This story also depicts the change in attitude

and views on health. It shows the impact and ef-

fectiveness of the services provided by the womens

health programme.

Hydie Sotela (Barangay Buntatala,

Leganes, Iloilo)

I am employed as a barangay health worker and

day-care teacher. Before the Gabriela health pro-

gramme, I depended mainly on Western medicine

prescribed by the doctor. When I joined Gabriela,

I learned how to use herbal medicines. I became

aware that, apart from the drugs available at the

pharmacy, the plants around us are alternative

medicines that can improve our health. I now ap-

ply what I learned from the training whenever any

member of my family is sick.

Before, I couldnt sleep at night because of my

asthma. I now use herbal medicine to treat the

symptoms. After taking it for a year, I now get fewer

asthma attacks. I also use it to inhale. Since I started

using herbal medicine, it has helped my family cut

the amount spent on mainstream medicines.

(2) Elma Deanon (Roxas City)

As Gabriela Roxas City chairperson, Deanon

reects the change in her views in her story, which

also indicates the impact of the whole programme

on her as a leader. She demonstrates how she is and

will remain committed to work for change.

Elma Deanon (Barangay Dinginan, Roxas

City)

Before, I always cried whenever I heard about

things that I didnt approve of. I was reluctant toget involved in issues that affect our society. Now

that Im part of the organization, I know our rights.

Thanks to the seminars and activities organized, I

now know what we can do. I try to understand all

the information Im given, and learn from it so that

I can pass it on to the communities where we are

working.

I learned from all of this that we should not keep

mum about injustice; we should not allow peopleto abuse or exploit us, because we all have rights.

I now know that I should ght back. Everything I

learn, I give back to the people, especially the poor

and the oppressed. We poor souls do not often get

the attention of the authorities, while the rich get

what they want. I told myself that one day things

would change.

When I became an organizer, something changed

in me. I began to stand up not only for myself but

also for the organization and the communities I am

serving.

(3) Emma Pedrano (Roxas City) see above.

Her story reects how the programme and the

organization empower women in the community to

take action to improve their situation.

1A barangay is the smallest entity in the Philippine government administration and refers to a village in a rural area.



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2.2.3 Assessment

Reections from the national ofce and from

Iloilo and Roxas organizers: the use of MSC

as an evaluation method was benecial to the

organizers and the programme staff. They were

enlightened as to what still needs to be done in

order to improve the method adopted or re-

ceived conrmation that it is an effective method

in a particular community.

For the organizers in the local chapters, thestories shared helped them gauge the level of

consolidation of the members and the capability

of the leaders. Through MSC, they were able to

not only assess the impact of the programme but

also indirectly appraise their organizing capa-

bility, and learned valuable lessons on how to

further develop that capability.

Assessment points

Since the MSC technique was quite new as a

method of evaluation, the facilitators were still

grappling with the process. They were worried

about how it would be used and appreciated

by the participants. The way in which the

MSC stories were collected was in itself a

learning process - for the participants, the

community organizers and the facilitators

themselves.

The facilitators were able to see how to modify

the procedure used in Iloilo after the assess-ment. Adjustments and modications were

made to improve the procedure applied during

the session with the Roxas City participants.

The Gabriela organizers in Iloilo and Roxas

City appreciated the MSC as an evaluation

method because they felt the stories reected

the impact of their work, which was not usu-

ally reported in formal assessments.

The facilitators decided to make the collection

of MSC stories a group activity to involve themembers of the organizations in the selection

of stories.

The method also brought to light the impor-

tance of following up on the development of

the members of the organizations at the local

level. These stories were not reported in the

conventional method of monitoring

programme progress at grassroots level.

The MSC technique will complement the data

reported in formal assessments.

The spontaneity of the participants narration

of their MSC stories is important. The par-ticipants should be able to freely express them

selves. One crucial factor is the language the

participants used. The local organizers helped

in translating the instructions and the stories

shared from Filipino to Hiligaynon (primary

language in Western Visayas) and vice versa.

There is a tendency for participants to enumer-

ate the benets they enjoy from being a mem

ber of the organization. There is a need for

the facilitator to reiterate to the participants

to focus on only one signicant change.

For the Iloilo chapter, the stories helped assess

the progress of the health programme. Most

of the stories were about how members had

beneted from the programme. Dur-

ing the process, points were raised about how

to advance the programme.

In Iloilo, most stories shared were about the

use of herbal medicines as part of the service

provided to the communities. The initial analy-

sis was that there is a need to put emphasis onempowering members in the communities.

The local chapters, however, are more

advanced and assertive when engaging the lo-

cal government on the issue of violence against

women and children, but this was not reected

in the MSC exercise.



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18

2.3 Latin America

In Latin America we work with a network that is part of the global Peoples Health

Movement. The Movimiento para la Salud de los Pueblos (MSP) is building the grass-

roots movement for the right to health across the continent. In consultation with the

MSP-LA, we decided to ask a local consultant, Mara Erlinda Sandino, to help us with

the introduction of the methodology. She worked with a coordinating team consisting

of Mara Hamlin Zuniga, Gabriel Garca, Arturo Quizphe and Jorge Quizphe to pre-

pare her report: INFORME VALORATIVO. Basado en Testimonios de Cambios Ms

Signicativos (CMS). The rest of this chapter consists of translated excerpts from

this report, which is available as a PDF document.

2.3.1 Methodology

From 2008 to 2010, the Latin American Peoples

Health Movement (PHM-LA) has been fostering

actions in the framework of the project Net-

work for the Right to Health in Latin America,

and is currently at the stage of developing new

plans.

Along these lines, the PHM-LA has decided to

evaluate the work from 2008 to 2010, using the

Most Signicant Change (MSC) technique, as

the groundwork for monitoring and follow-up

on the work being done, based on individual

and group reection, institutional learning, and

synergy among stakeholders.

The general objective of this exercise was: To

aid the organizations in the PHM-LA to iden-

tify, collect, and select Most Signicant ChangeStories (testimonios) about the experiences facili-

tated with the support of the movement during

the period 2008 to 2010.

Specic objectives:

1. Introduce the use of this methodology in

the PHM-LA, to strengthen leadership

structures and promote grassroots partici-

pation in the movement. 2. Visualize, share, and mobilize, using per-

sonal narratives and stories of local and

regional change about the most relevant

peoples health issues that have an impact

at the personal and societal level.

3. Use this experience to implement and

understand the MSC methodology and

form a small group of people in PHM-LA

who can act as facilitators of the MSCprocess in the near future.

Therst stepwas to form a technical team, made

up of Mara Hamlin Zniga, Arturo Quizphe,

Jorge Quizphe and Gabriel Garca (September

2010). An external facilitator was hired, who had

experience with the MSC technique in different

countries in the region, to aid in collecting and

editing the most signicant change stories and

support materials.

A review was done of documents on experiences

related to the PHM and of background material

on the MSC technique. A Guide to Collecting

Most Signicant Change Stories was designed

and revised, and shared with a group of repre-

sentative stakeholders.

During October, MSC stories were identied

and collected about the following experiences:

Experience with interculturality at the IPHU

course at ASECSA in Guatemala.

2 Experiences Latin America


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19

Defence of Mother Earth and the criminaliza-

tion of protest: Experiences from Guatemala

and Ecuador.

Right to health: Health Forum in El Salvador.

Living, thinking and feeling nature: The expe-

rience of Laicrimpo in Argentina.

Because the people and activities of PHM-LA

are located in different countries and territories

in Latin America, MSC had to be used crea-

tively; the collection of stories and feedback

on the results were done online, using e-mail

and Skype. The story of Crisanta Prez, on thecriminalization of the struggle to defend the

land, was put together from documents and a

lmed interview with Crisanta. It was not pos-

sible to get her story in person due to a tropical

storm emergency in Guatemala.

Using this input, this evaluation report was then

written, which systematizes the Most Signicant

Change Stories about selected experiences. The

stories have been grouped into a number of

main domains of change:

Domain of Change 1: Advocacy Capacity

Building.

Domain of Change 2: Political Advocacy in

Defence of Mother Earth and Against Crimi-

nalization of Protests to Defend the Land.

Domain of Change 3: Political Advocacy for

the Right to Health.

Domain of Change 4: Paradigm Shift inHealth.

Finally, feedback with the results of the MSC

process will be provided to the participants,

PHM-LA member organizations and the Third

World Relief Fund.



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2.3.2 MSC stories

Domain of Change: Advocacy Capacity Building IPHU Course1

Most Signicant Change Stories about the IPHU Course: Inclusion of an Intercultural

Approach

Story No. 1

The most signicant change for me as a

facilitator and student at the International

Peoples Health University was the ap-

proach used for the course, including the

ritual accompaniment during the entire

event.

I participated in the short course in Havana2 on the

social determinants of health and in Chimaltenan-

go3 on the topic of interculturality and health. I

felt a big difference, starting with the structure of

the classes; not only because of the syllabus, but

also because of the way we shared our feelings and

thoughts.

Havana was a marvellous course for meeting with

valuable, courageous people who talked about the

health situation in their countries, which in some

cases is very difcult. Something similar occurred

in Chimaltenango, but the difference is that theaccompaniment was essential. In Cuba, each day

was very intense and I did not feel that the setting

attended us in our process as people assimilating,

seeing and sharing these painful realities. They gave

us the best they could for facilities and accommoda-

tions, and also in human warmth; but the spiritual

accompaniment was missing.

In Chimaltenango, there was another way of ac-

companying, of knowing that they were there for

us, not only the organizers, but also the forces that

we invoked each day so that our classes would ow

in the best possible manner; we gave free rein to the

ow of emotions that are also part of what makes

us human and produce health in us.

From the beginning, we were received by the ances-tors who had been waiting for us; it didnt matter

how each of us decided to express our spirituality

or what name we gave it. Each person had the op-

portunity to connect with this other part that is very

ignored by the Western hegemonic perspective.

This other part is now the strength of our peoples;

Mother Earth makes herself strongly felt in our

hearts; she makes hope arise, even when we think it

is lost. She will make us, despite everything, keep on

defending and caring for life, starting with ourselves.

According to Vivian, rituality was an extremely

important part of the learning process in this

experience. She put it this way:

This is the most important thing for me, not only as a

doctor but also as a living human creature within the web

of life, because of the relevance of ritual. A sense of con-

nection with that which each one considers sacred, with

respect, going beyond fears, prejudices, racism, discrimi-

nation; I was capable of encountering the other personas a human creature and we would become brethren in

that sentiment, going beyond the differences that we might

Vivian Tatiana Camacho Hinojosa,

IPHU-Guatemala Course Facilitator.

From Cercado, Cochabamba, Bolivia.



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21

consider profound when speaking of spirituality. Because,

if we know and we experience the connection with the

life force, that will ensure that our direction, our walk, is

more coherent with the environment surrounding us and in

general with ourselves.

Vivian said that several physical elements

present during the course enabled a connection

with what she calls the life force:

The circular arrangement of the chairs facilitated

another way of sharing, each one learning from the other,

modelling an egalitarian structure instead of a hierarchy.The owers in the centre reminded us physically of that

which our eyes cannot seethe presence and force of our

ancestorsalso as part of our learning together.

It is in this coherence of knowing, feeling and

doing4that we nd motivation, courage and strength to

believe that we are capable of creating that other possible

world, knowing that there are also immense cruel forces

that are doing all they can to destroy; the personal, inter-

nal coherence makes us trust that each of our small stepsis also part of the great march toward that dignied, free

and mutually supportive life for all that we love, even for

human brothers and sisters who we dont know, who will

come after we are gone. Brothers and sisters of all living

species, we are all part of the Community of Life.

Among all of us, we are making mutually supportive

efforts to not weaken. Among all of us, we are building

hope with our hands and with our hearts, with our steps;

knowing that what we see and that which we cannot see

but can feel, are also life within life, as is each and every

one of us.

Involved in this story of change were the Maya

hosts, the Fathers and Mothers, who conducted

the welcoming and farewell ceremonies and

accompanied us each day; the participants; and

the organizers of the IPHU, who made the en-

tire event possible.

This experience took place at ASECSA, in Chi-maltenango, Guatemala, in April 2010.

Story No. 2

I was invited to participate in the IPHU in

Chimaltenango, Guatemala in April 2010

on the topic of Interculturality and Health,

as a facilitator.

This time, the course had a smaller, though suf-

cient, group, a syllabus that addressed topics that

turned out to be the experiences of the vast majori-

ty of the participants, all from the same region, withsimilar conditions and speaking the same language.

Even though some spoke an indigenous language

or Portuguese (those from Brazil), we all communi-

cated in Spanish.

I had already participated in the rst session of the

International Peoples Health University (IPHU)

in July 2005 in Cuenca, Ecuador. That rst session

was held during the Second Peoples Health Assem-

bly. At that rst course, we encountered a tradition-

al academic programme as far as organization goes,

but the subjects addressed were anything but.

In Ecuador, the course was characterized by a large

number of students, from different continents,

speaking different languages, which required a

whole set-up for simultaneous translation. It was

held on a university campus, and most of the

participants were PHM-LA activists or people new

to the movement, who were graduates of different

health elds.

In the experience in Chimaltenango, the general

topic of the course lent a certain academic level

William Hernndez M., IPHU-Guatema-

la Course Facilitator. From Managua,Nicaragua.



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22

In telling his story, William also said that this

change is the most relevant one because it in-

volved an approach based on the personal expe-

riences and reality of those involved, integratedinto an academic environment:

When we are talking about a place where community

health activists can share their experiences and obtain

knowledge tools in the framework of a university, it is

not possible to maintain the traditional, one-way educa-

tion model in which teachers, from a position as superiors,

Most Signicant Change Stories about the IPHU Course: Technology Innovation

to the session on Political Economy of Health.

All the academic formality was transformed into

a diverse collective, keen to share experiences and

thirsty for information, based on the personal stories

of the participants themselves, with collaboration

and guidance from a group of facilitators, which,

in my opinion, was the right decision by the organ-

izers.

transmit knowledge to a receiving group.

The Guatemala course used a model that was collective

and multi-directional. We all learned from all of the ex-

periences presented there, coming from different geographic,

social, cultural and academic places, which formed the

basis of the course.

We experienced the situation of the native peoples of

Guatemala, which led us to take on collective and individ-

ual commitments to work for a world with more solidarity

and harmony that produces life with health.

The IPHU organizing committee, the partici-pants and health activists from different peoples

and countries were involved in this change,

which took place at ASECSA, in Chimaltenan-

go, Guatemala in April 2010.

Story No. 3

Gabriel Garca Salyano, San Cristbal de

Las Casas. From Chiapas, Mxico.

Using communications technology for live

broadcast over the Internet, and using

open-access software, along with link-ins

with local radio stations to bring the IPHU-

Chimaltenango course to more people

throughout the Americas and broadcast

to rural Guatemala through a network of

community radio stations.

The experience in Chimaltenango dem-

onstrated that the use of this technology

and open-access software is not just for

experts and that it is within the reach of

all the organizations and individuals in the

PHM-LA and that it is useful for empower-ing and disseminating their activities.

Earlier, the events held in Porto Alegre and in

Havana had been conducted in the classic manner;

that is, only the participants were part of themin

the case of Havana because of the difculties from

the economic blockade and in Porto Alegre because

it seems that it simply wasnt something to take into

consideration. In general, information and commu-nications technology is underused in the PHM-LA;

perhaps because people dont know the potential it

has. In addition, practically everyone is limited to

using proprietary software, whether because they

dont know about other systems or because of a fear

of change.

According to Gabriel Garca Salyano, IPHU

courses are opportunities for the sharing, discus-

sion and evaluation of proposals for action fromand among different grassroots and academic sec-

tors and at the level of civil society organizations.

However, he said that earlier, this opportunity was



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23

for favoured individuals and was conducted

only as an on-site course.

The course in Chimaltenango, Guatemala was

the rst time that different presentations, plenary

sessions and discussions were broadcast live,

which meant that people from different parts of

Abya Yala could follow the course and send in

their comments and opinions about the subjects

and how the course was being taught.

This is important because there was a large

number of applicants to the course, which waslimited to 50 places; this meant that making the

course available to people who were off-site was a

spot-on decision.

Gabriel said that the teleconferences were of

good quality. They had the necessary equip-

ment, which was available to the institutions and

groups present and which facilitated making an

immediate audiovisual record of the event. This

was posted on the website along with all the otherinformation, making it available to everyone visit-

ing the site.

Another element that makes the use of com-

munications technology so important, according

to Gabriel, is that the organizing and facilitation

committee was comprised of people from differ-

ent countries: Guatemala, Nicaragua, El Salva-

dor, Mexico, Ecuador, Argentina and Bolivia.

Different Internet-based tools enabled them to

dene the selection criteria for the participants,

develop the subjects and content of the academic

programme, dene the roles of the participants

and organize the logistics, while decreasing envi-

ronmental and economic costs.

Those involved in this change were Virgilio Me-

dina, Jorge Contreras, Hazel Ros, Mara Hamlin

Zniga and Edy Rolando Siritit Quisquina. The

live broadcast of the event took place in Chi-

maltenango, Guatemala, with teleconferences on

12-14 April 2010, following preparations includ-

ing the purchase of necessary equipment and

training of the people involved (March 2010).

1International Peoples Health University.2 The IPHU in Havana was held in November 2009.3The IPHU in Chimaltenango was held in April 2010.4

Allin Yachay, Allin Munay, Allin Ruway = Allin Kawsay or Sumaj Kawsay. This means that to know well, love welland do well (with good thoughts, good feelings or a good heart; with doing good, in a good way) builds allin kawsay, the

good life; this also merges with sumaj, which means most beautiful life; that is, living beautifully in a good way is Sumaj

Kawsay, in harmony with all forms of life.



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Domain of Change: Political Advocacy in Defence of Mother Earth and Against the

Criminalization of Protest

Most Signicant Change Stories about the IPHU Course: Inclusion of an Intercultural

Approach

Story No. 4

Roco Prez, Leader of Victoria del Por-

tete Community and President of the

Defenders of Pachamama Womens Front

Community MSC Story:

We women organized, supported each other, built

our awareness and educated ourselves; we created a

juridical and legal entity to be able to protect, train

and inform ourselves and to train women lead-

ers who are part of the Defenders of Pachamama

Womens Front, from the communities of Tarqui,

Victoria del Portete, Molleturo, Limn Indanza,

Gualaquiza, Gualaceo, Cuenca, and others.

My community has not let itself be moved to thestage of exploitation, thanks to the resistance of

the Defenders of Pachamama Womens Front.

We maintain our love of life and nature, and also

for learning about the rights of women and of all

people.

Personal MSC Story:

I have learnt that I can help my community, defend

the water, land and life in general.... I have grown as

a woman and as a person.

Roco feels that this change is the most impor-

tant one because the women have successfully

fostered political advocacy activities pressuring

local, regional and national authorities, which

has led to changes in the law (amendments to

Ecuadors constitution). Before this, women wereignorant of their rights; but now they are organ-

ized. They belong to the Defenders of Pachama-

ma Womens Front and continue their struggle

to defend womens rights, environmental rights,

social rights and human rights in general.

As a result of their organizing and advocacy

capabilities they have counteracted the nega-

tive impact on the environment of transnational

mining companies: natural disasters, pollution,deteriorating living conditions, squalor and

poverty.

Roco Prez says that her struggle has enabled

the people living in the community of Victoria

del Portete to enjoy a healthy environment: We

can still breathe pure air and drink pure water and we

can also continue to enjoy our beautiful landscapes.

However, she emphasizes that they must con-

tinue the struggle and advocacy work, as says the

following: That we should never give up and that we

will be ready to ght, come what may.

This signicant change took place in the city

of Cuenca, Ecuador and involved Roco Prez,

leader and grandmother, together with other

grandmothers, all of them ghters, active and

militant in community action and defence of

their land in Victoria del Portete, Cuenca, Ecua-

dor.

24



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Most Signicant Change Story about the Experience with the Criminalization of Pro-

test: We are All Crisanta. San Marcos, Guatemala

Story No. 5

Crisanta Prez, San Miguel Ixtahuacn

Adapted from conversations with Crisanta

Prez and from the stories of struggle, We

are All Crisanta, a living history of women

leaders in defence of Maya land and dig-

nity.

In 2008 and 2009, Crisanta Prez became

a role model for many women in severalcommunities of San Marcos in defending

their rights, and they have raised the slo-

gan, We are All Crisanta.

According to written information and from talking

with Crisanta Prez, the problem is part of the ex-

ploitation of natural resources by the Marlin Mine,

run by the Montana Exploradora Company, a

member of Gold Corp, in San Miguel Ixtahuacn,

San Marcos, Guatemala.

In 2007, eight women from San Miguel Ixta-

huacn, led by Crisanta Prez, demanded that

the Montana Exploradora Company respect their

property after it ran electric lines for the mine over

family-owned lands and high tension lines over their

homes without prior authorization using manipu-

lated procedures, putting their lives at risk from

radiation and high voltage.

The companys lack of respect and its arrogance,

and the local peoples desire for safety, motivated

these brave women to knock down the electric poles

leading to the mine. Crisanta continues explaining:

They did not keep their promises, so what the woman did

was to remove the anchors from the post, and by taking the

anchors away, the post ipped over, and the electric lines go by

the corner of my house, so that worried me a lot, because if

the post were to fall it would damage my house.

What we did was le complaints with town hall, with theseal and signature of all the authorities from all the communi-

ties.... It was signed and sealed by them and they submitted an

25

ofcial document to the company (Marlin Mine) where they

asked the company to take the posts off my property and my

neighbours property.

So the company asked for another three months, but we told

them to take the posts away before the rains came because

when it rains the soil softens up. They had not removed the

light poles at the time when the rains began...so, I made up

my own mind then to block the companys electricity and now

the struggle belonged to the people. There were the people withthe cracked houses, those from the spring, the people with skin

disease.

The reaction of the company and of the Guatema-

lan government has been to issue arrest warrants

against Crisanta Prez, Crisanta Hernndez, Patro-

cinia Mateo, Catalina Prez, Olga Hamaca, Mara

Daz, Crisanta Yoc and Marta Prez. Since then,

these women live in hiding, going from community

to community where they are protected.

Because they were angry that I didnt make an agreement

with them they put an arrest warrant out for me. Here in San

Miguel, there are no people who speak Spanish so they asked

me to talk to the company manager to get them to take the

machinery away.

According to personal accounts, the company was

able to successfully install itself and strip-mine for

gold because they used force and deception, and

were supported by the Guatemalan government.This is seen as a continuation of colonialism and

as an act of arrogance and racism. The pillaging

continues and the local communities are not seen as

meriting any consideration or having any rights.

Most of the people are against the mining.

The company people came and I talked to them. I told them

what the problem was; why the people were against them

that they were defending their water sources, they didnt want

them to pollute their springs and their rivers where they washtheir clothes. The company didnt obey and again issued an

arrest warrant for me. I was at home when they called me



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to say that the police were already there.... I had to leave the

municipality of San Miguel.

Crisanta Prez, pregnant, decided to return to her

community to give birth. Shortly after giving birth

she was detained by National Civilian Police ofcers

and taken out of her home. The news spread quick-

ly through the communities; the people sounded the

alarm and blocked all roads out of town. In one of

these communities, an organized group of people

stopped the police and freed Crisanta Prez.

When I was pregnant, I was somewhere else; I was not

in San Miguel because there was an arrest warrant out forme. They looked for me here in Axil, so I had to leave and I

was three months pregnant when I left here. I returned in late

December; my daughter was born. One month after I had my

baby they caught me. I had spent six months somewhere else,

and in December I came back home again and after being

home for a month, they caught me.

This worries me a lot because my children are still small.... If

I didnt have little kids, well, I say, I would give my life for my

people.... Thank God Im not alone; many communities aresupporting me.

Crisanta is still being protected by the local people

and the ght to defend their land continues, under

the watchword, We are All Crisanta.

This story expresses a positive signicant change

and at the same time a negative signicant

change.

The negative change is the conditions of exploi-

tation, deception and lack of protection under

which the local peoplewomen, men, young

people, childrenlive, as well as the destruction

of the environment in different communities in

San Marcos, due to the arrogant, disrespectful

attitude and intrusion of the Montana Explo-

radora Company with the Marlin Mine, even

though it is in violation of national (Guatema-

lan) and international law.

According to Article 39 of the Constitution of

Guatemala, private property is guaranteed and

the government is the guarantor of the respect

of that right. Nevertheless, the countrys large

landholders use deception to strip peasant men

and women of the land they own. Their com-

munal lands and indigenous lands are expropri-

ated, in violation of their right to their territory

and of the international legal framework that

protects indigenous peoplesInternational La-

bour Organization (ILO) Convention No. 169.

The positive signicant change is Crisantas

ght, and that of other women and men from

San Miguel and other communities, to try toconvince local authorities to defend their proper-

ty and the natural resources of their indigenous

territory. This has motivated other women and

men, not only in Guatemala, but also in other

countries, to keep their struggle alive, and to

advocate in defence of their civil, political, social

and economic rights, as well as the collective and

territorial rights of the Maya people.



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Most Signicant Change Story about the Experience of the National Health Forum

with Political Advocacy. El Salvador

Domain of Change: Political Advocacy for the Right to Health

Story No. 6

Luz Margarita Posada, San Salvador, El

Salvador

Inclusion of our proposals and recommen-

dations in the ofcial document BuildingHope: Strategies and Recommendations

for Health 2009-2014, particularly Strat-

egy 4, Social and community participa-

tion, which says, Create structures and

procedures for community participation in

primary health care at all levels of the Sys-

tem. This is being done through advocacy,

lobbying, dialogue and negotiation, sup-

ported by the National Health Forum and

the new authorities, as part of Comprehen-

sive Health Reform.

With the arrival of the new health authorities in

June 2009, task forces were created to discuss health

policies and strategies.

Later, at an event in September 2009, Minister of

Health Dr. Mara Isabel Rodrguez swore in the

Organizing Committee of the National Health

Forum, chaired by Margarita Posada, Coordina-

tor of the Citizens Alliance against Privatization inHealth. There, the minister explained that Strategy

4 was included in response to constant demands.

The objective of this strategy is to facilitate citizen

participation in community health around the

country, through staggered regional consultations

with local actors, primarily from civil society, who

would then participate in a national conference to

strengthen, accompany and manage the process to

transform and develop the national health system.

According to Margarita, following the Peace

Accords ending the civil war in January 1992,

several civil society organizations working on

behalf of community health met, and in 1993

formed the Action for Health in El Salvador

(APSAL) network.

Since then, they have been engaged in oversight

and political advocacy with citizens proposals

regarding medicines and health reform.

The networks member organizations used to

present their proposals and initiatives to the

Ministry of Health and Social Welfare and

would engage in lobbying and dialogue, but

were never able to enter into talks: We never had

the opportunity to meet with anyone in the Health Minis-

try. The receptionist would just accept our correspondence

in the presence of the press, which we would convene, but

we would never get a response.

During the Social Security Institute strike in

2002, the number of supportive organizations

advocating against the privatization of health

care increased and the Citizens Alliance Against

Privatization in Health was formed. This new

forum again took up the issues of health reform,

medicines and the national budget.

Following the March 2009 elections, the pres-ident-elect was lobbied to appoint Dr. Mara

Isabel Rodrguez as Minister of Health, which



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he did. It was then that civil society was nally

able to establish dialogue with the new health

authorities. On 20 September 2009, the Presi-

dent of El Salvador spoke about Comprehensive

Health Reform and connected it to one of the

eight strategic areas of his administrationCiti-

zen Participationand the National Health

Forum was created as a mechanism for this

participation.

Margarita says that this change story is the most

signicant one because it has facilitated the

organizing work currently going on around thecountry in 138 of the countrys 262 municipali-

ties.

In addition, for each municipality, 10 three-

member community committees are being or-

ganized, for a total of 1,380 committees, which

are expected to cover 50% of the nation by

December 2010.

In this way, the public is becoming empoweredand working for the peoples right to health from

within organizing structures and participation

opportunities being implemented at different

levels:

I. National Health Forum (NHF) Commu-

nity Committees

II. NHF Municipal Intersectoral Coordinat-

ing Committees

III. NHF Departmental Coordinating Com-

mittees

IV. Regional Health Forums

V. NHF National Convention

Margarita: This has enabled having instruments and

discussion mechanisms for social auditing. The docu-

mentation will be given to the authorities, from whom we

will demand concrete changes in personnel and in health

care mechanisms.The idea of this is to ensure the

good functioning of the health system and to

ensure compliance with health reform.

Involved in this change were the civil society

organizations belonging to the Citizens Alliance

Against Privatization in Health: APROCSAL,

ASPS, APSIES, Las Mlidas, Comandos de

Salvamento, Union of Physicians of the Salva-doran Social Security Institute (SIMETRISSS),

Secondary School Students Movement (MES),

Consumer Defence Centre (CDC), CIDEP,

FUMA, Salvador Allende Professionals Move-

ment, Medical Society of El Salvador, PROVI-

DA, Medicus Mundi Andalusia, INTERVIDA,

PROMESA, independent professionals, Ministry

of Health authorities (minister and vice minis-

ters), and local organizations working around the

country.

This change took place from September 2009

to May 2010, and included the establishment

of the convening committee for the National

Health Forum, the Regional Forums (April-May)

and the First National Health Forum (28 May

2010).



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Most Signicant Change Story about the Experience of Laicrimpo: Living, thinking

and feeling nature

Domain of Change: Health Paradigm

Story No. 7

Marcela Bobatto and Gerardo Segovia, El

Dorado-Misiones, Argentina

Our way of understanding, thinking of and

feeling health and life changed. Our stancetoward life and daily living changed. Our

way of thinking about our being or stay-

ing healthy changed. Our way of relating

to everyone changed, because they are

no longer outside of us, they are not others;

rather they are part of us and us of them.

It committed us more to defending Mother

Nature, the environment, life as a whole.

We used to use a broad, comprehensive concept ofhealth, thinking that health is everything, it is the

relationship with oneself, with everyone else, with

God or the transcendental, and with nature. How-

ever, we still located ourselves outside of nature;

even though we were already thinking that we are

part of nature, there was a step missing, which

was to feel ourselves as nature. We are wind, we are

earth, we are re, we are trees, we are water, we are

seeds.

Now, to be in harmony with oneself, among our-

selves, enables increasing the harmony in the all.

This harmony occurs when natures diversity and

all its elements are present in our group, in our

community.

When, symptoms, diseases or conicts appear with-

in ourselves, the group or the community, harmony

is lost. But, by realizing this, by being conscious thatwe hold everything inside ourselves and that we

are able to interrelate with everything, we have the

possibility of recovering that harmony. In essence,

we are an interrelated ALL, and the health and life

of each and every living being depends on each and

every living being. We are Life within Life.

At a certain point along the way, and with the essen-

tial support of indigenous peoples, rural communi-

ties and the sharing of different practices, knowingand doing, we realized, we experienced, we became

conscious, of our being nature, that WE ARE

NATURE.

We are not outside, nor above nature, we are not its

owners, we cannot do what we want with it, neither

are we part of nature; rather, we are one with

nature. During this process, we shifted our concept

from an anthropocentric paradigm to a biocentric

paradigm. We began to experience OUR nature, to

feel that we belonged to the cosmos; to understand,perceive and experience that I am and we are water,

wind, re; that we are earth, that the elements that

are in nature pass through us, belong to us, are in

our make-up, they are in us and we are in them.

By feeling ourselves as trees, earth, plants, moun-

tains, being responsible for the stewardship of

Mother Earth and all living things with which we

share Life emerges more strongly.

Therefore, when the current capitalist model, which

revolves around accumulation and prot, promotes



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eviction, extraction and extinction, causing suffering

and death, we also feel within ourselves the suffering

of the other beings with whom we are experien-

tially interconnected.

This signicant change has its history in the

experience of the Laicrimpo Peoples Health

Movement, since its beginnings, with its area

of work reecting on and exploring concepts,

including the concept of health.

Marcela and Gerardo say that over the years, the

experience of the Laicrimpo Salud movementbecame more profound, and shifted its concept

of health as the absence of disease, to a concept of

comprehensive health, which is understood as the

relationship with oneself, with everyone else (the

social area), with the transcendental and with

nature, in addition to the driving idea behind

this the concept: health in the hands of the commu-

nity.

This change is considered to be very impor-tant because it demonstrates the capacity of

the members of the Laicrimpo movement to

change, and experience a paradigm shift in

their daily lives: [This change is the most important]

...because it produces a change in our way of understand-

ing, thinking, feeling, doing, acting, in our lives and in

our daily activities. It enables us to develop more healthy

relationships with ourselves, with others, with nature, with

the planet, with the cosmos. Because it contributes to the

development of a new paradigm that strongly questionsthe current paradigm. It changes how we act.

The change involves individuals and groups

belonging to the Laicrimpo Salud Peoples

Health Movement; among these, housewives,

health workers, teachers, peasant farmers,

indigenous people, professionals from a variety

of disciplines and church workers from different

denominations.

This change took place during the local and pro-vincial meetings held yearly by the Laicrimpo

Saludmovement around Argentina, during the

30

last three years with the accompaniment of the

PHM-LA.



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2.3.3 Assessment

This rst experience with using the Most Signi-

cant Changes (MSC) technique has fostered in-

dividual reection with several key actors in the

movement and the identication of stories that

reveal the most relevant changes that have taken

place as part of the PHM-LA from 2008 to

2010. MSC encouraged these people to discuss

their insights and to evaluate their experiences

with change that have had signicant impact

in the domains of local and national action;changes that benet the most vulnerable groups

of peoplewomen, youth, children, older

adults, indigenous peoplesin the framework of

defending their rights.

The Most Signicant Change stories are centred

on four domains of change: 1) Advocacy Capac-

ity Building; 2) Political Advocacy in Defence of

Mother Earth and Against the Criminalization

of Protest; 3) Political Advocacy for the Right to

Health; and 4) Paradigm Shift in Health.

Even though each of the experiences has its own

context, idiosyncrasies, actors and organizations,

they all took place as part of the PHM-LA and

identify with it. They all contribute to achieving

the objective: The Peoples Health Movement Latin

America (PHM-LA) is an effective instrument for advo-

cacy and action for the right to health in Latin America.

The experiences We are All Crisanta in Gua-temala and the Defenders of Pachamama Wom-

ens Front in Ecuador demonstrate the political

advocacy and activism that took place because

of the criminalization of protest in those places,

with the involvement of community groups, and,

in particular, the struggle of women in defence

of their civil rights: the right to health, the right

to education and economic, political, environ-

mental and cultural rights.

The experience of the National Health Forum

in El Salvador highlights the participation of civ-

il society in lobbying, dialogue and negotiation

processes with local and national authorities,

resulting in signicant progress in health policy

and strategic community health actions.

The stories also reveal the capacities and skills of

the PHM-LAs member organizations to have a

positive effect on developing public policy that

is supportive of the right to health locally and

nationally. However, there were no stories col-lected regarding political advocacy in regional

and global settings.

The people who were consulted during this

process expressed, both in their Most Signicant

Change Stories and in the wider conversations

(via Skype) attitudes, values, principles and phi-

losophies consistent with the movements values

and principles. These key actors and other citi-

zens are promoting the ri

PHM HISTORIAS

Documents

Transcript of PHM HISTORIAS